围孕产期甲状腺疾病相关诊疗指南的解读

Interpretation of Related Guidelines for Diagnosis and Treatment of Thyroid Diseases During Preconceptional and Perinatal Period

正常的甲状腺功能对围产期母体和胎儿的健康尤为重要。越来越多的研究发现,甲状腺疾病可能会导致女性不孕,增加妊娠期高血压、甲状腺危象、自然流产、早产和死产等妊娠相关并发症,并可能损害后代的神经智力发育。妊娠期甲状腺发生特有的生理性变化,使妊娠期甲状腺疾病的诊断标准有别于非妊娠妇女,且此疾病的症状、体征常与妊娠期的生理性表现重叠,增加了临床诊断的难度。甲状腺疾病是围孕产期常见的内分泌疾病,其病情复杂、诊疗策略需兼顾母婴安全,国内外专业学会相继发布了相关的更新指南,对该疾病临床管理中的具体问题给出了详细建议。结合目前最新的研究证据,对国内外新近指南中的诊治要点进行对比分析及解读,为临床医生对围孕产期甲状腺疾病的诊治提供参考。

In the peripartum period,euthyroidism is essential for maternal-fetal health.More and more studies have found that thyroid diseases may lead to female infertility,increase the risk of pregnancy-related complications such as gestational hypertension,thyroid crisis,spontaneous abortion,preterm birth,and stillbirth,and may impair the neurological and intellectual development of offspring.The diagnostic criteria of thyroid diseases during pregnancy are different from those of non-pregnant women due to the unique physiological changes of thyroid in this special period.Moreover,the symptoms and signs of perinatal thyroid diseases often overlap with the physiological manifestations of pregnancy,which increases the difficulty of clinical diagnosis.Thyroid diseases are common endocrine disease in the peripartum period,and its situation is complex,its diagnostic and treatment strategies should consider the safety of both mothers and infants.Relevant updated guidelines have been issued by domestic and foreign professional societies,which provided detailed suggestions regarding clinical managements of thyroid diseases during peripartum period.This review combined with the latest research evidence comparatively analyzes and interprets the main points of diagnosis and treatment of the recent guidelines at home and abroad,in order to provide references for clinicians regarding the diagnosis and treatment of perinatal thyroid diseases.